From the Department of Anesthesiology, Peking Union Medical College Hospital, Beijing, China.
Central Research Laboratory, Peking Union Medical College Hospital, Beijing, China.
Anesth Analg. 2020 Sep;131(3):840-849. doi: 10.1213/ANE.0000000000004342.
Patients with lung cancer often experience reduced functional capacity and quality of life after surgery. The current study investigated the impact of a short-term, home-based, multimodal prehabilitation program on perioperative functional capacity in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for nonsmall cell lung cancer (NSCLC).
A randomized controlled trial was conducted with 73 patients. Patients in the prehabilitation group (n = 37) received a 2-week multimodal intervention program before surgery, including aerobic and resistance exercises, respiratory training, nutrition counseling with whey protein supplementation, and psychological guidance. Patients in the control group (n = 36) received the usual clinical care. The assessors were blinded to the patient allocation. The primary outcome was perioperative functional capacity measured as the 6-minute walk distance (6MWD), which was assessed at 1 day before and 30 days after surgery. A linear mixed-effects model was built to analyze the perioperative 6MWD. Other outcomes included lung function, disability and psychometric evaluations, length of stay (LOS), short-term recovery quality, postoperative complications, and mortality.
The median duration of prehabilitation was 15 days. The average 6MWD was 60.9 m higher perioperatively in the prehabilitation group compared to the control group (95% confidence interval [CI], 32.4-89.5; P < .001). There were no differences in lung function, disability and psychological assessment, LOS, short-term recovery quality, postoperative complications, and mortality, except for forced vital capacity (FVC; 0.35 L higher in the prehabilitation group, 95% CI, 0.05-0.66; P = .021).
A 2-week, home-based, multimodal prehabilitation program could produce clinically relevant improvements in perioperative functional capacity in patients undergoing VATS lobectomy for lung cancer.
肺癌患者手术后常出现功能能力和生活质量下降。本研究调查了短期、家庭为基础、多模式术前康复方案对非小细胞肺癌（NSCLC）行电视辅助胸腔镜手术（VATS）肺叶切除术患者围手术期功能能力的影响。
这是一项随机对照试验，共纳入 73 例患者。术前康复组（n = 37）接受为期 2 周的多模式干预方案，包括有氧运动和抗阻运动、呼吸训练、乳清蛋白补充的营养咨询和心理指导。对照组（n = 36）接受常规临床护理。评估者对患者分组情况设盲。主要结局为围手术期功能能力，以术前 1 天和术后 30 天的 6 分钟步行距离（6MWD）评估。建立线性混合效应模型分析围手术期 6MWD。其他结局包括肺功能、残疾和心理测量评估、住院时间（LOS）、短期恢复质量、术后并发症和死亡率。
术前康复的中位持续时间为 15 天。与对照组相比，术前康复组围手术期平均 6MWD 增加 60.9m（95%置信区间[CI]：32.4-89.5；P <.001）。两组在肺功能、残疾和心理评估、LOS、短期恢复质量、术后并发症和死亡率方面无差异，但用力肺活量（FVC）方面，术前康复组高 0.35L（95%CI：0.05-0.66；P =.021）。
为期 2 周、家庭为基础、多模式的术前康复方案可显著改善行 VATS 肺叶切除术肺癌患者的围手术期功能能力。
